Healthcare Provider Details

I. General information

NPI: 1114410131
Provider Name (Legal Business Name): JONATHAN HILLERICH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2018
Last Update Date: 12/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

226 SE 8TH AVE
HILLSBORO OR
97123-4218
US

IV. Provider business mailing address

PO BOX 6149
BEAVERTON OR
97007-0149
US

V. Phone/Fax

Practice location:
  • Phone: 503-601-7385
  • Fax: 503-601-7325
Mailing address:
  • Phone: 503-352-8642
  • Fax: 503-352-8658

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH-0016908
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: